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Do Test Scores Make the Doctor?

Doug Menuez/Getty ImagesWhat qualities are important for success in medical school, and beyond?

In today’s Doctor and Patient column, Dr. Pauline W. Chen tells the story of a young student who wants to be a doctor. Dr. Chen writes:

Not long ago, a friend confessed that her son, who spends much of his free time volunteering at a children’s hospital and who is applying to medical school, has been particularly anxious about his future. “His test scores are just O.K.,” my friend said, the despair in her voice nearly palpable. “I know he’d be a great doctor, but who he is doesn’t seem to matter to medical schools as much as how he does on tests.”

Her comment brought me back to the many anxious conversations I had had with friends when we were applying to medical school. Over and over again, we asked ourselves: Do we really need to be good at multiple-choice exams in order to be a good doctor?

I’m a doctor, just finished med school last year and currently in training. I’ve generally been good at school with good test scores, etc. In spite of all that, I will say this is the most challenging thing I’ve done in my life. It’s not the committment or the dealing with difficult situations that’s difficult. It’s mastering as much of the knowledge as I can. No matter how much time I spend reading, studying, and learning, I never feel like I know enough. I agree that a multiple-choice test is not equivalent to the challenges I face, but I will say that yes, you have to be smart, with a good memory, good problem solving skills, and serious committment to be good at what you do. To the degree that tests assess these things, then yes, they are necessary. Just being caring alone is not enough.

“Do we really need to be good at multiple-choice exams in order to be a good doctor?”

(a) Yes, because everybody is the same, and there is always a single right answer for every patient. “Statins, metformin, beta blockers, low-dosage aspirin, and come back in 6 months.”

(b) Yes, because in the real world of insurance companies, government regulators and lawyers, doctors get punished and/or sued for malpractice if they don’t follow the same mainstream practices as everybody else, even if those practices are wrong.

(c) No, because real patients don’t fit into neat little categories in the 15 seconds that it takes too ill in a test oval. Speedy test answering habits discourage doctors from taking time to listen to patients.

(d) No, because formulaic thinking does not lead to new discoveries and innovations, like the serendipitous discovery of penicillin, or Pasteur’s advocacy of hand-washing by doctors.

This article is perfectly timed… I just quit med school to change careers because, though I have high B’s in my med school classes, and A’s in my clinical classes, I can’t seem to pass the 8 hour multiple choice USMLE Step 1.

I KNOW I’m good with patients, my clinical grades reflect this. I have excellent bedside manner and I get along very well with both patients and attendings. Meanwhile, it is painful to watch unsocial, un-empathetic, and often aloof classmates of mine barely interacting with patients and moving on in medicine because they were just good at taking standardized tests.

Not only is the Medical school acceptance system in the US antiquated, but the concept of standardized tests as measurements of a physician’s capabilities are just another example of the American school system being held hostage by large test-makers like the College Board.

I have been a doctor for 37 years. It is one of the most complicated and knowledge based professions, and personality can not compensate for inferior cognitive skills.
When patients talk about doctors they always say he was nice first, but when they are seriously sick, personality is unimportant. Some of the worst results I have seen have been due to stupidity and incompetence even though the doctors had very nice personalities. There is little teaching in medical school on niceness and professors are chosen mainly for their research abilities. Chiropractors have much emphasis on personality and so do cults.
Definitely the best and most successful doctors combine intelligence with personality.

All things being equal, a smart doctor is better than a stupid doctor.

Personality tests only work when the test-taker is answering honestly. If they were used for high stakes purposes, Princeton Review would write a book about how to answer the questions “correctly” instead of honestly.

Conclusion is that the current selection system works well enough. Perhaps we could get doctors more interested in being doctors by lowering salaries. High salaries make medicine a default career for a lot of people who aren’t truly interested in being a doctor.

AheMCAT Test question: What about your doctor is most important to you?
a) how fast I can get an appointment
b) whether s/he seems personable and knowledgeable
c) that my insurance pay for my consultations and treatment
d) that there be plenty of interesting magazines in the waiting room
e) that they give me free samples of medications the prescribe
f) if they remember my name
g) if they remove the correct kidney during surgery (presuming that’s what you need)
h) how good their golf game is
i) how sparkling white their lab coat is
j) if they can save my life on that rare occasion when I need that.

Nice Jim. My niche is filling in the typical doctor’s weakness gap – (d). Getting good test scores as a doctor in school assures you of only one thing – that you learned the information really well. The quality of the doctor then, is based on the accuracy of the information. When it comes to some topics, particularly the relationship between illness and diet, or how saturated fat and cholesterol affect heart disease risk, or caloric intake and body weight – those who get the best test scores were best at learning the wrong information. I’d rather go to a doctor that barely passed his finals if I wanted some health and nutrition counsel.http://www.180degreehealth.com/heart-disease-cholesterol.html

What a dumb misguided pseudo-scientific paper on physicians selections.
There is hundreds of varieties of practices, and only one selection process, on scholastic achievements, because they are accepted and quantifiable.
As long as we will keep the same criteria,accepted even by the victims, we will have the same complains.
Each of us as physician should look back and see if the best students have produced the best physicians , whatever speciality or geography of practice.
Selection is not iindended tom pick the best, but it is intended to limit the numbers of practionners, to protect the profession from overpopulation,not to improve the overall quality.
Sincerely
Gerard Guiraudon

Personality tests dont account for the very different types of jobs physicians have, depending on their specialty. Sure, I would love a primary care doctor who was extroverted and friendly, but it wouldn’t make a difference if my pathologist was that way, or my radiologist. I’d much rather have a smart but introverted anesthesiologist than a non-smart but extroverted one, especially since most of the time I spend under her care I’ll be sound asleep

One could make the counterargument that personality and intelligence are not two opposing parts of a zero-sum game, and that it’s possible to have both. To that I say sure, it is possible to have both, but much more rare as well. Until some magic cure comes along that makes people both smart, conscientious, and extroverted at the same time (I’d love to have the patent on that, cha-ching!), med schools have to work with the applicants that they have. That’s why when making cognitive ability the limiting factor rather than personality will ensure at least some baseline quality assurance of students in their freshman class.

To begin with, the very personality test referred to in this article is itself a standardized multiple choice test, so acting as though it’s only the cognitive tests that suffer from the defect of being standardized tests is pretty off base. Does anyone imagine that, if these personality tests were to become part of the decision process, students wouldn’t figure out how to game them too?

But what really bothers me about the article is the claim that medical schools need to worry about how well students hold up under the stress of their medical training. Earth to medical establishment: medical school is stressful most importantly because it is deliberately made so. It becomes effectively a kind of hazing. How many potentially sensitive doctors have been turned out from medical school because they couldn’t abide the absurd stresses placed upon them as students? Why must or should training doctors involve a process worst than boot camp? Why imagine that that brutalizing process doesn’t by itself both select for and create a callous group of physicians?

Despite what medical leaders seem to suggest, the life of a physician is rarely one in which ability to deal with tremendous stress is critical. It isn’t war, for God’s sakes, when an internist or a radiologist or a dermatologist or a gastroenterologist or a psychiatrist perform the vast majority of their duties. Why, then, select only for those who might best be able to handle tremendous stress by inducing it in their training?

As with virtually all hazing, the real goal is to achieve a feeling of being part of an elite that should be accorded special treatment and admiration by outsiders. But isn’t it obvious that this very attitude plays a crucial role in the arrogance so many see in physicians as a group? Why on earth encourage practices that encourage, rather than ameliorate, that attitude?

The article presents an interesting idea but at the end it seems to confuse two different issues–success in medical school and being a good doctor. The article begins by examining how the prediction of medical school success can be aided by personality tests but concludes by discussing what it means to be a good doctor. The Belgian study simply measured medical school performance, not how a good doctor a person becomes (whatever that means). The penultimate paragraph seems out of sync with the rest of the article. For better or worse, our medical schools have already decided which characteristics they want the doctors that they produce to have; this is reflected in the way medical students are currently evaluated.

given how competitive it is to get into medicine, surely we can find people who have both personality and smarts.

#3 SH, i don’t care how good you are at the bedside, if you can’t come up with the answers, you shouldn’t be a doctor. doesn’t make you a bad person, just not a good doctor. we are doctors, not nurses, not therapists, not hand-holders.

the questions is, do smart, conscientious, personable young people even want to go into medicine anymore? trust in medicine and its practitioners is rapidly eroding, making this field increasingly less rewarding.

Hmm, #6, we’ve already lowered compensation for primary care MDs, so by your theory we should have hordes of people wanting to work in primary care specialties.

We all want our doctors to be knowledgeable, but when you read online comments about doctors, a lot of the satisfaction (or lack thereof) centers on his/her personality, the efficiency and friendliness of the front office, and the responsiveness to their concerns. Most people have no idea whether their doctors are really “smart”. Do we make mistakes in the admissions processes? Sure. Can hard work make up for cognitive liabilities? Absolutely. The main problem is that the way many medical schools continue to do business is grounded in 19th and early 20th century methods. Change is occurring in terms of selection, curricula, and evaluation, but it remains to be seen how much of a difference (or when) it will make in the physician workforce.

Frankly with my well-being or even survuval on the line, i want the doc with the most knowledge and grasp of latest methodology & research. I can find nice and pleasant interaction with my friends & family.

Empathy and congeniality are fine qualities, but should not be a measure of actual knowledge & diagnostic acumen. Perhaps those qualities are more important in the second tier of primary care providers-PAs & NPs. Give me the smartest MD, not the nicest.

I will be entering medical school this August (deferred for a year to accept a Fulbright fellowship) and have helped several friends with their applications this year, so this topic is definitely near (if not dear) to my heart.

The MCAT is just another standardized test. Is it useful? Yes, because not all college classes are as rigorous as they should be, so med schools need some sort of national yardstick. No, because it doesn’t measure a lot of things that might be better indicators of how someone will do in medical school/as a doctor. For those pre-meds who haven’t figured it out yet, working doctors are tested for the rest of their lives, so get used to it! Step 1-3, boards, then CME and re-taking boards or passing additional certifications every several years, but obviously the most important test is how the patients fare.

The current application process does somewhat consider personality through recommendation letters and interviews, but this too has flaws. For example, at one school, my interviewer was an organ transplant surgeon (no offense, Dr. Chen) who had absolutely no interest in hearing about why I was thinking about entering primary care/public health. However, I would agree with commenter #5 that the current system works fairly well – a standardized personality test probably wouldn’t help because people can fake answers and the real test of personality is how you interact with another person, not another multiple-choice answer sheet.

Studies have also been published showing that students with lower MCAT scores are at higher risk of malpractice suits or disciplinary action by their medical board once they are practicing. Certainly empathy and conscientiousness are important parts of being a physician, but there has to be a certain critical mass of raw intellect as well. I’d prefer being treated by someone who is a bit gruff over someone who reads a chest xray incorrectly.

Of course being good at multiple choice tests is not necessary to be a good doctor; however, being adequate enough at multiple choice tests so that you can get into one of the numerous medical school programs should be doable. If not, there are alternatives, OD school, PA, etc. Being a health care provider is not only about being a MD.

My sister didn’t test well, heck, she was barely average at my school, Phillips Exeter, but she got into Stanford and went to Baylor Med, and is now a very good and successful doctor. College and med school are NOT all about test scores, but you have to compensate in some way. Someone who shows high social skills and is committed to caring, should be able to illustrate those attributes through recommendations, interviews and essays.

I know of a few people who did really well on the MCAT and had amazing grades in school and they are the WORST kind of people imaginable. It’s scary because these people are anticipating becoming doctors and “caring” for people when they couldn’t give a sh*t about what happens to their future patients.

When some students perform poorly in academics, they would hope that medical schools look past those discrepancies and weigh their personality and passion more than academics. Sometimes I think about this when I realize how AWFUL a “C” on my transcript looks or a 35Q on the MCAT compared to a student with a 4.00 and a perfect MCAT. Knowing that medical schools probably do not care about who I am as a person prior to an interview encourages me to study harder and perform better on exams.

I would be a student with okay grades, an “acceptable” MCAT score, and strong passion than a perfect student who is completely awful and fake as a $3 bill.

I graduated from medical school in 1967 when there were 9-13 applicants per medical school slot (depending on the school). I agree that the personal interaction with patients is critical and vital and I continue to spend as much time as I feel is necessary, if at all possible, with each patient. Often the simple laying of a hand on a patient’s shoulder and saying, “I understand…”is of invaluable help to them in dealing with a medical challenge, regardless of their problem. Unfortunately everything that has occurred since my graduation works in the other direction and is being compounded by some of the proposed reforms.

The cost of a medical education (funded by the state in Europe), after completion of 4 years of the expense of a college education, leaves many students with debts often $250,000 or higher. Given the diminishing payments to physicians and the ongoing devastation the need to practice defensive medicine continues to place on the doctor-patient relationship, the obvious consequence has been to decrease the patient-doctor interaction (now seen intrinsically as potentially adversarial) and the time allocated to it in favor of more rapid through-put of the patient to provide the volume to maintain a doctor’s practice as financially viable. I am all in favor of graduating empathetic physicians. I consider myself such a physician and I am glad to be in a stage of my career when I can afford to do so. But the powers that be will further erode the ability of even the most empathetic of physicians to continue to bring the “heart” of medicine into the doctor-patients relationship. Time is money and empathy takes time.

The recent demand of the Republican minority to potentially filibuster a bill that would have prevented the just implemented Medicare reimbursement cuts in honor of their new-found fiscal responsibility will further cut the time per patient visit. Similarly the refusal of both parties to deal with the malpractice crisis leads to the exorbitant increased in cost caused by the practice of “defensive” medicine.

The drop in applicants per slot to medical school by 4-5 fold already demonstrates the effect of what has and is being done to the appeal of medicine as a profession.

Giving a personality test to medical students would be a bad idea– since the application process is so competitive, test-takers would simply say whatever they thought the medical school wanted to hear.

Applicants have already invested years of their life getting ready for med school– they have a huge incentive to highlight aspects of their personality that would provide them with a beneficial score.

The whole idea of standardizing medical student personalities is a little weird…. Genius is unpredictable.

Medical school is about the most bureaucratic system I’ve ever encountered– so I’m not surprised that the idea of standardizing personality is being taken seriously.

Attrition is okay– but perhaps students shouldn’t accumulate $100,000 in loans before they find out that they made a mistake.

The study Dr. Chen quotes used people with relatively high test scores, since they were already in med school. It clearly shows that personality is important.

Not mentioned here is that there is also a correlation between MCAT test scores and performance. In particular, those with very low scores performed the worst.

Since we have so many applicants, we can pick and choose. Those with low MCAT scores are still out. Those with low personality scores should be out, also, no matter what their MCAT scores.

Obviously you want students with the highest scores in both categories (elite med schools), but most schools should end up with most students having high scores in one category, and medium in the other, which is OK.

OK, I’ll jump in. I think doctors need to be well-adjusted. Emotionally mature. Whatever the term is. I see they did a test for neurotic tendencies–I saw some doc in training on the Dicovery Channel say he could NEVER be a gyno because he hated feet and the woman’s feet were near his face. I thought that was…interesting Some doctors who comment on here also show disdain, almost hatred, for people who eat sweets and are still fat, and so on. Many docs won’t touch you or do so seemingly reluctantly. They look at numbers from tests (in the hosp sometimes, the hospitalists as they call them hardly talk to the patient, just order tests, read numbers, order meds or more tests). Often doctors under their much-discussed time constaints, talk with you with their hand on the doorknob. At least this has been my experience. I could be wrong. I read once standards for entrance were lower than say, 30 yrs ago. I can believe this from some of the doctors I have met. Or maybe Dr Welby never existed except on TV.

I would say a physician should be even-tempered, inwardly calm, able to stick a task, then take the next task, be interested in people with all their weird histories and vocations and avocations, and have a caring nature…Some people just have that–they often think of others first. I remember in stark relief the one and only time a doctor called ME and said, “I was just thinking about your eye…and…” One time! He left to go teach at the Univ of Florida. So these incoming students will be getting someone good.

A smart doctor is better than a stupid doctor, sure. But the real question is “what is the optimal balance of intelligence, knowledge, and personality traits that makes a good doctor?”

What if personality traits are as important as or more important than MCAT score?

The MCAT is in a lot of ways like a crude IQ test. Suppose we gave med school applicants IQ tests instead. Does it matter on a day-to-day level whether your doctor has an IQ of 125 or an IQ of 140?

What if it doesn’t matter? What if it turns out that IQ 125 doctors with extroverted personalities are on average better doctors than IQ 140 doctors with introverted personalities?

Is there a baseline MCAT score above which personality traits become more important to success than the MCAT score?

I agree, no doubt that applicants would learn how to “properly” answer any standardized personality tests, just as they learn how to game the MCAT and the SAT. The solution is not to abandon personality traits in the search for good doctors, but to take into account indicators of personality traits that are much harder to fake.

You said “Perhaps we could get doctors more interested in being doctors by lowering salaries. High salaries make medicine a default career for a lot of people who aren’t truly interested in being a doctor.”

That doesn’t seem to have worked very well for us in K-12 education.

You said “Conclusion is that the current selection system works well enough.”

But that’s the problem. You can’t draw that conclusion because you have no way of comparing the current system to one that might work substantially better for similar levels of investment. In which case it would turn out that the current system is drastically impoverished as a means for doing right by the health of our people.